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The Cost-Effectiveness of Neurological Diagnostic Tests

Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, and Associate Editor Robert Holloway, MD, MPH, FAAN, discuss the challenges of measuring the value of neurodiagnostic tests, with a dearth of available data on efficacy.

Results from exome-sequencing suggest lysosomal storage gene variants may predispose some people to PD, according to a new study presented at the AAN Annual Meeting. Brent Fogel, MD, PhD, FAAN, associate professor of neurology and human genetics at University of California, Los Angeles, discusses the possible clinical ramifications — the potential to target lysosomal pathways — with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, of the University of Colorado, and Associate Editor Robert G. Holloway, MD, FAAN, of the University of Rochester. Read more about the study: http://bit.ly/NT-PDLysosomal.

Results from a meta-analysis presented at the AAN Annual Meeting suggest resuming oral anticoagulation after an ICH decreases mortality risk and results in better outcomes. In a discussion with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, of the University of Colorado, and Associate Editor Robert G. Holloway, MD, FAAN, of the University of Rochester, Larry B. Goldstein, MD, FAAN, FAHA, chair and professor of neurology at the University of Kentucky, said residual confounding factors among other limitations with this type of analysis must be considered when weighing these findings. Read more about the study: http://bit.ly/NT-AnticoagulationICH.

Sepsis may contribute to the risk of long-term seizures, according to a study presented at this year’s AAN Annual Meeting. Joseph I. Sirven, MD, FAAN, chair and professor of neurology at the Mayo Clinic in Phoenix, AZ, discusses the clinical implications of the study in a discussion with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, of the University of Colorado, and Associate Editor Robert G. Holloway, of the University of Rochester. Read more about the sepsis and seizures association: http://bit.ly/NT-SepsisSeizures.

The FDA-approved drug, nusinersen, and gene therapy agent, AVXS-101 were both found effective for SMA in studies presented at the AAN Annual Meeting. Brent Fogel, MD, PhD, FAAN, associate professor of neurology and human genetics at University of California, Los Angeles, discusses the underlying pathogenesis of SMA and the difficult clinical decisions that each presents with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, of the University of Colorado, and Associate Editor Robert G. Holloway, of the University of Rochester. Read more about nusinersen results and the AVXS-101 study: http://bit.ly/NT-NusinersenGeneTherapy.

Stenting rates for carotid-artery stenosis have not declined, despite evidence suggesting endarterectomy may be more effective, according to a study reported at the AAN Annual Meeting. In a discussion with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, of the University of Colorado, and Associate Editor Robert G. Holloway, of the University of Rochester, Larry B. Goldstein, MD, FAAN, FAHA, chair and professor of neurology at the University of Kentucky suggests that each therapy should be compared with medical therapy, and that findings from CREST-2 should provide more information for clinical decision-making. Read more about the study: http://bit.ly/NT-StentingStenosis.

Neurology Today editors interview Kristina Simonyan, MD, PhD, associate professor of neurology and otolaryngology at the Icahn School of Medicine at Mount Sinai, and Serena Bianchi, PhD, a post-doctoral fellow in Dr. Simonyan’s laboratory, about their imaging studies showing structural differences between different phenotypes and genotypes of spasmodic dysphonia.

Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, and Associate Editor Robert Holloway, MD, MPH, FAAN, discuss the challenges of measuring the value of neurodiagnostic tests, with a dearth of available data on efficacy.

A meta-analysis of 5 trials found that the procedure was more effective for stroke, the sooner it was performed, but remained effective up to 7.3 hours after symptom onset – significantly longer than the current guideline window of 6 hours. Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, and Associate Editor Robert Holloway, MD, MPH, FAAN, discuss what the findings mean for stroke treatment and minimizing time to reperfusion.

A 5-year follow-up study found that deep brain stimulation (DBS) of the subthalamic nucleus improved motor function for people with early-stage Parkinson’s disease compared to medical treatment alone. The study’s principal investigator David Charles, MD, FAAN, professor and vice chairman of neurology at Vanderbilt Neuroscience Institute, discusses the advantages and complications of treating patients in early stages of the disease with the Neurology Today editors.

Over time, medical therapy for unruptured brain arteriovenous malformations (AVMs) led to fewer strokes and deaths than surgical intervention, according to a five-year analysis of data from the randomized ARUBA trial. Vladimir Hachinski, MD, FAAN, professor of neurology at the University of Western Ontario, discusses the clinical ramifications of the new data in this interview with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, and Associate Editor Robert G. Holloway Jr., MD, FAAN. Read the Neurology Today article about the study here: http://bit.ly/ARUBA-NT.

Elevated levels of sulfonylurea receptor-1 (SUR1), in cerebrospinal fluid may be a potential biomarker of edema after traumatic brain injury, and slower declines in Sur1 levels is associated with worse clinical status, according to a study by investigators at the University of Pittsburgh Medical Center. Watch as Neurology Today Editor-in-chief Dr. Steven P. Ringel, FAAN, and Associate Editor Dr. Robert G. Holloway Jr., FAAN, discuss the study with Kevin N. Sheth, MD, FAAN, chief, of the division of neurocritical care & emergency neurology at Yale New Haven Hospital. Read the Neurology Today article about the study here: http://bit.ly/SUR1-NT

Optical coherence tomography (OCT), which is used to measure retinal thickness, can help clinicians predict multiple sclerosis (MS) progression two to five years later, according to an international longitudinal cohort study presented at the 2016 AAN Annual Meeting and published in Lancet Neurology. Steven P. Ringel, MD, FAAN, and Associate Editor Dr. Robert G. Holloway Jr., MD, FAAN, discuss the study with Peter Calabresi, MD, FAAN, director of the neuroimmunology division at Johns Hopkins University. Read the Neurology Today article about the study here: http://bit.ly/OCT-MS.

Patients who are treated with tissue plasminogen activator (tPA), or alteplase, treatment for ischemic stroke may not need a routine computed tomography (CT) scan, according to a study by researchers at University of North Carolina. Commenting on the study, Vladimir Hachinski, MD, FAAN, professor of neurology University of Western Ontario, emphasized that doctors should evaluate the need for a CT scan for each patient individually depending on the type of stroke they had. Watch as Neurology Today Editor-in-chief Dr. Steven P. Ringel, FAAN,and Associate Editor Dr. Robert G. Holloway Jr., FAAN, discuss the study with Dr. Hachinski.

Can women with epilepsy get pregnant as easily as healthy women? Yes, according to a new study that challenges conventional wisdom that women with epilepsy have a more difficult time getting pregnant. Watch here as Neurology Today Editor-in-Chief Steven P. Ringel, MD, FAAN, and Associate Editor Robert G. Holloway Jr., MD, FAAN, discuss the implications of the findings with study author Page Pennell, MD, director of research in the epilepsy division at Brigham and Women’s Hospital in Boston. Read the Neurology Today article about the study here: http://bit.ly/NT-fertility.

A new study by a team of researchers at the Alzheimer's Disease Center at Rush University Medical Center suggests that diabetes is not associated with the hallmark pathology of Alzheimer's disease. Rather, the data show that cerebrovascular disease — brain infarcts — associated with diabetes can lead to dementia, and that larger infarcts, rather than very small ones, seem to play a role. The Neurology Today editors discuss the findings with Alzheimer's disease expert Steven T. DeKosky, MD, FAAN, deputy director of the McKnight Brain Institute and professor of neurology at the University of Florida.

A high-fat diet mouse model induced neuropathy similar to that observed in patients with pre-diabetes and type 2 diabetes. Work with the model suggests that tightly controlling blood glucose is not sufficient to prevent the development or progression of peripheral neuropathy in type 2 diabetes. An emerging concept is that diabetic neuropathy is associated with metabolic syndrome, and not hyperglycemia alone. The Neurology Today editors discuss the model and how it could translate into new research targets for peripheral neuropathy with Eva Feldman, MD, PhD, FAAN, director of the A. Alfred Taubman Medical Research Institute and Program for Neurology Research and Discovery at the University of Michigan.

The Neurology Today editors analyze two new studies that track readmission rates among neurology patients in hospitals throughout the US with S. Andrew Josephson, MD, a professor and senior executive vice chair of the University of California, San Francisco.

What’s behind the pathological process of proteins misfolding and aggregating in conditions such as Alzheimer’s and multiple system atrophy? The Neurology Today editors analyze insights from two new papers with David M. Holtzman, MD, FAAN, professor and chair of neurology at Washington University School of Medicine in St. Louis.

In this video, our editors discuss a new study that suggests that transthyretin could serve as the first gene-specific biomarker for ALS and frontotemporal dementia. Dr. Brent Fogel discusses the findings with Neurology Today Editor-in-chief Dr. Steven Ringel and Associate Editor Dr. Robert Holloway Jr.

In this video, our editors discuss a study that investigates the ability of clinicians to predict which patients will go on to develop mild cognitive impairment. Neurology Today Editor-in-chief Dr. Steven Ringel and Associate Editor Dr. Robert Holloway Jr. discuss the findings with Alzheimer’s disease expert Dr. David Gill.

Results from exome-sequencing suggest lysosomal storage gene variants may predispose some people to PD, according to a new study presented at the AAN Annual Meeting. Brent Fogel, MD, PhD, FAAN, associate professor of neurology and human genetics at University of California, Los Angeles, discusses the possible clinical ramifications — the potential to target lysosomal pathways — with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, of the University of Colorado, and Associate Editor Robert G. Holloway, MD, FAAN, of the University of Rochester. Read more about the study: http://bit.ly/NT-PDLysosomal.

Results from a meta-analysis presented at the AAN Annual Meeting suggest resuming oral anticoagulation after an ICH decreases mortality risk and results in better outcomes. In a discussion with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, of the University of Colorado, and Associate Editor Robert G. Holloway, MD, FAAN, of the University of Rochester, Larry B. Goldstein, MD, FAAN, FAHA, chair and professor of neurology at the University of Kentucky, said residual confounding factors among other limitations with this type of analysis must be considered when weighing these findings. Read more about the study: http://bit.ly/NT-AnticoagulationICH.

Stenting rates for carotid-artery stenosis have not declined, despite evidence suggesting endarterectomy may be more effective, according to a study reported at the AAN Annual Meeting. In a discussion with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, of the University of Colorado, and Associate Editor Robert G. Holloway, of the University of Rochester, Larry B. Goldstein, MD, FAAN, FAHA, chair and professor of neurology at the University of Kentucky suggests that each therapy should be compared with medical therapy, and that findings from CREST-2 should provide more information for clinical decision-making. Read more about the study: http://bit.ly/NT-StentingStenosis.

Neurology Today editors interview Kristina Simonyan, MD, PhD, associate professor of neurology and otolaryngology at the Icahn School of Medicine at Mount Sinai, and Serena Bianchi, PhD, a post-doctoral fellow in Dr. Simonyan’s laboratory, about their imaging studies showing structural differences between different phenotypes and genotypes of spasmodic dysphonia.

A 5-year follow-up study found that deep brain stimulation (DBS) of the subthalamic nucleus improved motor function for people with early-stage Parkinson’s disease compared to medical treatment alone. The study’s principal investigator David Charles, MD, FAAN, professor and vice chairman of neurology at Vanderbilt Neuroscience Institute, discusses the advantages and complications of treating patients in early stages of the disease with the Neurology Today editors.

Over time, medical therapy for unruptured brain arteriovenous malformations (AVMs) led to fewer strokes and deaths than surgical intervention, according to a five-year analysis of data from the randomized ARUBA trial. Vladimir Hachinski, MD, FAAN, professor of neurology at the University of Western Ontario, discusses the clinical ramifications of the new data in this interview with Neurology Today Editor-in-chief Steven P. Ringel, MD, FAAN, and Associate Editor Robert G. Holloway Jr., MD, FAAN. Read the Neurology Today article about the study here: http://bit.ly/ARUBA-NT.

Elevated levels of sulfonylurea receptor-1 (SUR1), in cerebrospinal fluid may be a potential biomarker of edema after traumatic brain injury, and slower declines in Sur1 levels is associated with worse clinical status, according to a study by investigators at the University of Pittsburgh Medical Center. Watch as Neurology Today Editor-in-chief Dr. Steven P. Ringel, FAAN, and Associate Editor Dr. Robert G. Holloway Jr., FAAN, discuss the study with Kevin N. Sheth, MD, FAAN, chief, of the division of neurocritical care & emergency neurology at Yale New Haven Hospital. Read the Neurology Today article about the study here: http://bit.ly/SUR1-NT

Patients who are treated with tissue plasminogen activator (tPA), or alteplase, treatment for ischemic stroke may not need a routine computed tomography (CT) scan, according to a study by researchers at University of North Carolina. Commenting on the study, Vladimir Hachinski, MD, FAAN, professor of neurology University of Western Ontario, emphasized that doctors should evaluate the need for a CT scan for each patient individually depending on the type of stroke they had. Watch as Neurology Today Editor-in-chief Dr. Steven P. Ringel, FAAN,and Associate Editor Dr. Robert G. Holloway Jr., FAAN, discuss the study with Dr. Hachinski.

Can women with epilepsy get pregnant as easily as healthy women? Yes, according to a new study that challenges conventional wisdom that women with epilepsy have a more difficult time getting pregnant. Watch here as Neurology Today Editor-in-Chief Steven P. Ringel, MD, FAAN, and Associate Editor Robert G. Holloway Jr., MD, FAAN, discuss the implications of the findings with study author Page Pennell, MD, director of research in the epilepsy division at Brigham and Women’s Hospital in Boston. Read the Neurology Today article about the study here: http://bit.ly/NT-fertility.

A new study by a team of researchers at the Alzheimer's Disease Center at Rush University Medical Center suggests that diabetes is not associated with the hallmark pathology of Alzheimer's disease. Rather, the data show that cerebrovascular disease — brain infarcts — associated with diabetes can lead to dementia, and that larger infarcts, rather than very small ones, seem to play a role. The Neurology Today editors discuss the findings with Alzheimer's disease expert Steven T. DeKosky, MD, FAAN, deputy director of the McKnight Brain Institute and professor of neurology at the University of Florida.

A new proof-of-principle study used inexpensive tablets and video conferencing software to screen stroke patients en route to the hospital. Dr. James Grotta discusses the most promising advances in assessing stroke in the ambulance with Neurology Today Editor-in-chief Dr. Steven Ringel and Associate Editor Dr. Robert Holloway Jr.

A new study uses contrast-enhanced MRI to show blood-brain barrier breakdown in the aging hippocampus. Here, Berislav Zlokovic, MD, PhD, director of the Zilkha Neurogenetic Institute and professor of physiology and biophysics at the University of Southern California in Los Angeles, discusses what the study means for future research.

At the 2014 AAN Annual Meeting, investigators reported the results of a double-blind, placebo-controlled, international multi-center study of selisistat in individuals with Huntington’s disease (HD). They found that, apart from increases in liver function tests in a subset of patients, selisistat was safe and well tolerated. In this video, Neurology Today Editor-in-chief Steven P. Ringel, MD, and Neurology Today Associate Editor Robert G. Holloway Jr., MD, MPH, discuss the meaning of these results with David Holtzman, MD, professor and chair of neurology at Washington University in St. Louis. See the full meeting abstract here: http://bit.ly/HD-neuro.

A new study presented at the 2014 AAN Annual Meeting calls into question the use of hyperosmolar therapy for treating intracerebral hemorrhage (ICH). In a review of outcomes from a registry of patients with ICH, investigators said those treated with hyperosmolar therapy experienced significantly worse outcomes than those who did not receive the treatment. Will these findings alter ICH care? What additional research is necessary to confirm these findings? In this video, see the answers to these and other questions in a panel discussion with Neurology Today Editor-in-chief Steven P. Ringel, MD; Neurology Today Associate Editor Robert G. Holloway Jr., MD, MPH; Vladimir Hachinski, MD, professor of neurology and epidemiology at Western University in Ontario; and Jeffrey L. Saver, MD, director of stroke and vascular neurology at the University of California in Los Angeles.

Medical marijuana appears to help alleviate spasticity and central or spasm-related pain and some other multiple sclerosis symptoms, but there is little evidence of efficacy in treating epilepsy or movement disorders, according to two systematic reviews published by the AAN earlier this year. In this video, Neurology Today Editor-in-chief Steven P. Ringel, MD; Neurology Today Associate Editor Robert G. Holloway Jr., MD, MPH; and Neurology Editor-in-Chief Robert A. Gross, MD, PhD, discuss the available evidence for medical marijuana use in neurological disorders, as well as the lingering gaps in knowledge.

Why did Neurology issue a call for papers on negative trial outcomes? What value is there in publishing negative results and what are the benefits for neurology as a specialty? Watch here as Neurology Editor-in-chief Robert A. Gross, MD, PhD, professor of neurology and of pharmacology and physiology at University of Rochester Medical Center, answers these questions and more in an interactive dialogue with Neurology Today Editor-in-Chief Steven P. Ringel, MD, professor and director of the Neuromuscular Division at the University of Colorado School of Medicine, and Neurology Today Associate Editor Robert Holloway Jr. MD, chair and professor of neurology at University of Rochester Medical Center. Read the original Jan. 16 Neurology Today report, “Nearly One-Third of Large Clinical Trials Go Unpublished — in Neurology, Too”: http://bit.ly/1heTZab.

At this year’s AAN annual meeting, investigators reported that among the neurodegenerative disorders associated with REM sleep behavior disorder (RBD), 94 percent were synucleinopathies, indicating, experts
say, that REM sleep behavior disorder is a highly
significant prognostic indicator of future neurodegenerative disease. The findings “argue that part of the selective vulnerability
involved with Lewy body disease and with MSA likely involves REM sleep circuitry,” study leader Bradley Boeve, MD, chair of behavioral neurology at the Mayo Clinic in Rochester, MN, told attendees of the plenary at the AAN annual meeting. In a video interview, Neurology Today

Editor-in-chief Steven P. Ringel, MD, and Associate Editor Robert G. Holloway, MD, discuss the implications of the study and what to tell patients and their families once REM sleep behavior disorder is diagnosed.

From the AAN Annual Meeting: In a post-mortem analysis of brains from the Honolulu-Asia Aging Study, investigators found that people who had been treated with beta blockers alone showed fewer microinfarcts, less brain atrophy, and fewer brain lesions of the type linked to Alzheimer’s disease. In a video interview, Neurology Today editorial advisory board member David Gill, MD, a cognitive behavioral neurologist at Unit Rehabilitation & Neurology in Rochester, NY, comments on the key clinical take-aways from the study and suggests questions for future research.

In April, Richard E. Popwell Jr., MD, chairman of the Bozeman Deaconess Health Group Executive Council in Bozeman, MT, traveled to Aurora, CO, to observe the quality measures and patient safety systems in place at the University of Colorado Hospital with his Emerging Leaders Forum mentor, Neurology Today Editor-in-Chief Steven P. Ringel, MD. Watch here as Dr. Popwell discusses with Dr. Ringel the efforts at the nonprofit Bozeman Deaconess to help their physicians better “capture” and measure their work habits effectively to make best use of the relative value unit-based system for compensation. For the full-text version of this article, see the July 4 Neurology Today.

A video demonstration of the Epley maneuver by the American Academy of Neurology. Visit neurology.org/content/70/22/2067.full.pdf for the associated AAN guideline on treating benign paroxysmal positional vertigo (BPPV).

The way neurology researchers communicate to their patients about their participation in trials may contribute to negative expectations about results, contributing to a nocebo effect, investigators report, based on a meta-analysis of studies. What can neurologists do to minimize the nocebo response? Watch here as Neurology Today Editor-in-chief Steven P. Ringel, MD, and Associate Editor Robert Holloway, MD, discuss strategies for improving communication with patients about participation in trials.